Advance Directives Information & Do Not Resuscitate Orders summahealth.org
Contents Information About Advance Directives 4 You Have a Choice 4 What are my rights in choosing my medical care? 5 What if I am too sick to decide and cannot make 5 my wishes known? What kinds of forms are there? 5 Living Will 5 What is a Living Will? 5 Can I change my Living Will or Healthcare Power 5 What is the difference between a Living Will and a 7 Healthcare Power Do the people giving me medical care have to follow 7 my wishes? If I have a Healthcare Power of Attorney, do I need 7 a Living Will too? If I do not have an Advance Directive, who chooses 7 my medical care if I cannot? How does an Advance Directive differ from a DNR Order? 7 Do Not Resuscitate (DNR) Order 8 What is a DNR order? 8 What is DNR Comfort Care and DNR Comfort Care-Arrest? 8 Healthcare Power of Attorney 6 What is a Healthcare Power 6 Whom should I choose to be my Healthcare Power 6 When does my Healthcare Power of Attorney take effect? 6 Declaration for Mental Health Treatment 6 Anatomical Gifts 6 Registering to become an organ, tissue and eye donor 6 Frequently Asked Questions About 7 Advance Directives Do I have to fill out an Advance Directive before 7 I get medical care? Who can fill out an Advance Directive? Do I need a lawyer to fill out an Advance Directive? 7 DNR Comfort Care 8 DNR Comfort Care-Arrest 8 Summa Health System offers a third form of DNR Order 8 Other Matters to Think About 9 When might artificially supplied food and water be stopped 9 or not used? In Ohio, who is considered Next of Kin? 9 By filling out an Advance Directive, am I participating in 9 euthanasia or assisted suicide? 9 Practical Matters 9 Where can I get Advance Directive forms? 9 What should I do with my forms after filling them out? 9
You Have the Right: Stating Your Wishes Regarding Medical Treatment Information About Advance Directives Summa Health System recognizes a patient s right to accept or refuse medical and surgical treatment. It also recognizes a patient s right to make Advance Directives, which are directions given by a person describing the kind of healthcare s/he would like to recieve if s/he lost the ability to make decisions independently. Under Ohio law, the three following types of Advance Directives are accepted: Living Will, Healthcare Power of Attorney and the Declaration for Mental Heath Treatment. Making an Advance Directive is completely voluntary. Summa Health System will provide the same high-quality care whether you have an Advance Directive or not. If you would like more information regarding Advance Directives, please ask your doctor. Summa Health System is required by state and federal law to: Give written information to each patient about his or her rights under state law to make decisions about medical care. This includes the right to accept or refuse medical and surgical treatment and the right to make Advance Directives. Note in the patient s medical record whether or not the patient has made an Advance Directive and include a copy of the Advance Directive as part of the medical record. Provide education for staff and the community about Advance Directives. You Have a Choice Many people worry about the medical care they might receive if they become too ill to make their wishes known. Some people may not want to spend months or years on life support, while others may want every step taken to lengthen their lives. A growing number of people are choosing to make their medical care wishes known while they are still healthy and able to choose make their own choices. Your health care facility must explain your right to state your wishes about medical care and ask you if you have already put your wishes in writing. This brochure explains your rights, under Ohio law, to accept or refuse medical care. This brochure also tells you how you can state your wishes about the care you would want if you could not choose for yourself. Although this brochure will help you understand your rights under the law, it does not contain legal advice. For legal advice, you may want to speak with your lawyer. For information about free legal services, call 800.589.5888, Monday through Friday, 8:30 am to 5:00 pm. What are my rights in choosing my medical care? You have the right to choose your own medical care. If you do not want a certain type of care, you have the right to tell your doctor you do not want it. What if I am too sick to decide and cannot make my wishes known? Most people are able to tell their doctor their choice for medical care. However, some people become too sick to tell their doctors what type of care they want. Under Ohio law, you have the right to fill out a form while you are able to speak for yourself. This form tells your doctor what you want done if you cannot make your wishes known. What kinds of forms are there? Under Ohio law, there are three different forms, or Advance Directives: A Living Will, a Healthcare Power of Attorney and a Declaration for Mental Health Treatment. Advance Directives may only be completed while you are able to speak for yourself. The Advance Directives tell your doctor and others your wishes about your medical care under particular circumstances. Living Will What is a Living Will? A Living Will is a document that allows you to establish, in advance, the type of medical care you would want to receive if you were to become permanently unconscious, or if you were to become terminally ill and unable to tell your physician or family what kind of life-sustaining treatments you want to receive. In addition, a Living Will allows you to specify your wishes regarding anatomical gifts (organ and tissue donation). A Living Will is used only in situations where you are unable to tell your physician what kind of health care services you want to receive. Before your Living Will goes into effect, you must be either: 1. terminally ill (see definition as described in the Living Will Declaration Form) and unable to tell your physician your wishes regarding health care services; OR 2. permanently unconscious. To be considered permanently unconscious, two physicians (one of whom must be a medical specialist in an appropriate field) must decide you have no reasonable possibility of regaining consciousness. Can I change my Living Will or Healthcare Power Yes, you can change your advance directives any time. Only you can change or cancel your Living Will or Healthcare Power of Attorney. If you already have an Advance Directive, make sure it follows Ohio s law. You may want to contact a lawyer for help when filling out the form. It is a good idea to review your Advance Directive from time to time to ensure you designate it still states your wishes and that the person is still available. Your wishes as stated in a Living Will always takes precedence over your Healthcare Power of Attorney. 4 Behavioral Health Services Behavioral Health Services 5
Healthcare Power of Attorney A Healthcare Power of Attorney is different from a Durable Power of Attorney for finances. A Healthcare Power of Attorney allows you to choose a trusted person to give permission to carry out your wishes only for your medical care. The person decides for you if you cannot decide for yourself, whether for a short or long while. Whom should I choose to be my Healthcare Power You can choose any adult relative or friend you trust to decide for you when you cannot decide for yourself. Be sure you talk with the person about your wishes. The person you choose must follow your wishes. Then write down what you do and do not want on your form. You should also inform your doctor of your wishes. Declaration for Mental Health Treatment The Mental Health declaration allows you to state your preferences regarding your mental health treatment and to name a person to make mental health care decisions for you when you cannot make these decisions for yourself. Those who would benefit from having such a document include people who have been diagnosed with mental illness and people who find themselves or may find themselves in circumstances that would warrant a mental health declaration, including those of advanced age or those who have developed an illness that likely will include a mental component as it progresses. Before you complete a Declaration for Mental Health Treatment, it may be helpful to contact your lawyer and discuss your options available. Your lawyer can help you complete the Declaration for Mental Health Treatment. It is also important that you discuss your treatment preferences with any mental health professional providing services to you. Additional information can be obtained from the Ohio Advocates for Mental Health or Ohio Legal Rights Service (see Web site at www.olrs.ohio.gov). The Declaration for Mental Health Treatment supercedes a Healthcare Power of Attorney, but does not supercede a Living Will. Anatomical Gifts Ohio law requires that Living Wills created after December 15, 2004 include a person s preferences about Anatomical Gifts (organ and tissue donations). The Living Will form has the required section and also provides instructions for registering your wishes with the Bureau of Motor Vehicles. Living Wills completed before December 16, 2004 that do not include the Anatomical Gifts (organ and tissue donation) section are still valid and will be honored. If you previously gave consent for your organs, tissue, and/ or eyes, if usable, to be removed upon your death, the revised Living Will form allows you to be specific regarding the type(s) of organ/tissue you wish to donate and for what purposes. When does my Healthcare Power of Attorney take effect? The form takes effect only when you cannot choose your care for yourself and ends when you can make your own choices. Unlike a Living Will, it is not limited to situations in which you are terminally ill or permanently unconscious. The Healthcare Power of Attorney can only stop life support if you are permanently unconscious or terminally ill. Frequently Asked Questions About Advance Directives Do I have to fill out an Advance Directive before I get medical care? No. Filling out an Advance Directive is completely voluntary. Who can fill out an Advance Directive? Anyone 18 years or older who is of sound mind and can make his or her own decisions can fill out an Advance Directive. Do I need a lawyer to fill out an Advance Directive? No, but you do have the right to consult with a lawyer, if you wish. Anyone 18 years or older who is of sound mind and can make his or her own decisions can fill out an Advance Directive. because they go against his or her conscience or belief system. If so, he/she will help you find someone else who will follow your wishes. If I have a Healthcare Power of Attorney, do I need a Living Will too? You want both. Each addresses different parts of your medical care. A Living Will makes your wishes known directly to your doctor, but only states your wishes about the use of life-support methods. A Healthcare Power of Attorney allows the person you choose to communicate your wishes for all of your medical care when you cannot communicate for yourself. A Healthcare Power of Attorney does not overrule a Living Will. Registering to become an Organ, Tissue and Eye Donor In addition to registering your intent to become a donor, you should discuss your wishes with your family. For specifics on registering to become an organ, tissue and/or eye donor and other donor facts, please visit the Web site www.donatelifeohio.org or call LifeBanc at 216.752.5433 or 1.800.558.5433. What is the difference between a Living Will and a Healthcare Power Your Living Will explains, in writing, the type of life support medical care you would want if you could not make your wishes known and you are either (1) terminally ill or (2) permanently unconscious. Your Healthcare Power of Attorney lets you choose a person to communicate your wishes if you cannot communicate for yourself. Do the people giving me medical care have to follow my wishes? Yes, if your wishes follow state law. However, Ohio law includes a conscience clause. A person giving you medical care may not be able to follow your wishes If I do not have an Advance Directive, who chooses my medical care if I cannot? Ohio law allows your next of kin to choose your medical care if you are expected to die and cannot act for yourself. Your next of kin can also decide to stop or not use artificially supplied food and water in consultation with the physician (see Other Matters to Consider, page 7). How does an Advance Directive differ from a DNR order? An Advance Directive tells your physician, family, and other members of the health care team your wishes about your medical care under certain circumstances. A DNR is a treatment order from a physician, certified nurse practitioner or clinical nurse specialist. 6 Behavioral Health Services Behavioral Health Services 7
Do Not Resuscitate (DNR) Order What is a DNR order? A Do Not Resucitate oreder is an order written by a physician, certified nurse practitioner or clinical nurse specialist telling health care providers not to attempt to perform cardiopulmonary resuscitation (CPR) or similar procedures on a patient if his or her heart or breathing stops. A DNR order is typically used for persons with advanced chronic illnesses, serious conditions from which recovery is not expected, terminal illnesses or persons who are very frail and would not be helped by CPR. A DNR order is usually written after discussion with the patient and/or surrogate or family. What is the difference between DNR Comfort Care and DNR Comfort Care-Arrest? Ohio offers two types of DNR orders. DNR Comfort Care DNR Comfort Care states that only comfort and supportive care measures will be used before, during, and after a person s heart or breathing stops. If a DNR Comfort Care order is written, no attempt will be made to perform CPR or to prolong the dying process. Comfort and supportive care measures typically used include suctioning, oxygen, repositioning, control of bleeding, providing medication for pain and other symptoms, emotional support and contacting other appropriate health care providers. DNR Comfort Care-Arrest DNR Comfort Care-Arrest states that helpful medical interventions will be used until the heart or breathing stop and then only comfort and supportive care measures will be used. No CPR or other resuscitation measures will be attempted. Summa Health System DNR Form In addition to these, Summa Health System has a third form of DNR order that clarifies additional treatments. The Summa Health System DNR specifies whether mechanical ventilation (a breathing machine that provides life support) will be used. The Summa Health System DNR form is only effective while a person is an inpatient. When a person leaves the hospital, even if it is to go to an Extended Care Facility, he/she must have a State of Ohio DNR Comfort Care Identification Form if appropriate. The Ohio DNR Form requires a physician order. Other Matters to Consider When might artificially supplied food and water be stopped or not used? Artificially supplied food and water means you receive food and/or water by way of tubes placed inside your body. Whether artificially supplied food and water would be stopped or not used depends on your medical condition and what you state in your Living Will, which could include: If you are expected to die and cannot make your wishes known, and your Living Will states you do not want life-support used to lengthen your life, then artificially supplied food and water can be stopped or not used; If you are expected to die and cannot make your wishes known, and you do not have a Living Will, then Ohio law allows your next of kin to determine when to stop using artificially-supplied food and water. If you are permanently unconscious, and your Living Will states you do not want artificially supplied food and water, then artificially supplied food and water may be stopped or not used, or; If you are permanently unconscious, and you do not have a Living Will, the Ohio law allows your next of kin to stop or not use artificially supplied food and water. In order of priority, your next of kin are your: Your next of kin are your, in order of priority: 1. Spouse 2. Adult Children 3. Parents 4. Adult Siblings By filling out an Advance Directive, am I participating in euthanasia or assisted suicide? No, withdrawing medical treatment with your consent is not the same as euthanasia or assisted suicide. Your choices outlined in this brochure are in accordance with Ohio law. Ohio law prohibits euthanasia and assisted suicide. Practical Matters Where can I get Advance Directive forms? Many of the people and places that give you medical care have Advance Directive forms. Ask the person who gave you this brochure for an Advance Directive form - a Living Will, a Healthcare Power of Attorney or a Declarationfor Mental Health Treatment form. The forms may be obtained at Summa Health System Hospitals from any social worker, on the internet at www.ohpco or summa s Web site at summahealth.org/advancedirectives What should I do with my forms after filling them out? You should give copies to your doctor and health care facility to put into your medical record. Each time you come to the hospital, bring a copy with you. Give one to a trusted family member or friend. If you have chosen someone as a Heathcare Power of Attorney, give that person a copy. Put a copy with your personal papers. You may want to give one to your lawyer or clergy person. Be sure to tell your family or friends the people closest to you about what you have done. Do not fill out these forms and just put them away and forget about them. More information is available at: www.ohpco.org; www.co.summit.oh.us/fiscaloffice/index 8 Behavioral Health Services Behavioral Health Services 9
Summa Resources Summa Health System Akron Campus Summa Health System St. Thomas Campus Social Work - 330.375.3145 Patient Liaison - 330.375.3925 Forms are available at summahealth.org/advancedirectives. Summa Health System Barberton Campus Social Work - 330.615.3132 Patient Advocate - 330.615.4046 Forms are available in the Patient Registration area and at summahealth.org/advancedirectives. Western Reserve Hospital Social Work - 330.971.7162 Case Management - 330.971.7183 Summa Health Wadsworth-Rittman Medical Center Social Services - 330.331.1649 Risk Management - 330.331.1641 Forms are available in the Patient Registration area and at summahealth.org/advancedirectives. This brochure was developed using information from the Ohio Department of Job and Family Services. Reviewed and approved by Summa s Ethics Committee, 7/09 10 Behavioral Health Services Behavioral Health Services 11
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